Abstract
Background and Objective:The objective of this review was to determine whether surgery, in comparison to conservative treatment, is a safe and effective intervention for the management of distal femoral growth plate fractures.Methods:A systematic literature review was performed using a three-step search strategy. The PubMed, Embase and Scopus databases were utilized to identify current studies from 1 January 1990 to 8 January 2017. Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments. Primary outcomes of interest were rates of growth arrest and angular deformity.Results:Of the 7740 studies identified with the search, 15 case studies with data inclusive of outcomes of interest were selected for inclusion. A total of 466 patients were included.The rate of complication in the surgical population was 37.8%. In the conservative population the rate of complication was 34.0%. Five of the 15 papers showed Salter-Harris (SH) classification to correlate with prognosis, three papers showed the presence of displacement to correlate with prognosis which would have had an influence on the results of these higher graded injuries likely to have been managed operatively. A high rate of position loss and subsequent growth abnormalities was observed when conservative management was instituted.Conclusion:The rate of complication was marginally higher in the surgical population than that in the conservative population. This study also identified that higher severity distal femur physeal fractures, determined by the amount of displacement and Salter Harris grade, may associate a poorer outcome. It appears that managing higher severity distal femoral physeal injuries conservatively would be less likely to achieve and maintain reduction and therefore associate higher risks of malunion with subsequent growth arrest, leg length discrepancy and angular deformity as compared with surgical intervention. Further studies with higher patient numbers and comparable cohorts are needed to compare surgical and conservative interventions for the lower severity distal femoral physeal fractures.
Highlights
The physis of the distal femur is inherently weaker than the ligaments of the knee
This review considered studies that evaluated surgical and conservative treatments for distal femoral growth plate fractures in the acute hospital setting
This review considered studies that included the following outcome measures:
Summary
A distal femoral physeal injury in children is fraught with numerous potential complications [4, 6 - 9]. Complete or partial growth arrest is commonly seen, which may manifest clinically in leg length discrepancy and angulation deformity [9]. Limitation on knee motion, quadriceps atrophy, osteomyelitis or osteoarthritis may result from this injury [9 - 11]. A meta-analysis by Basener [23] studying distal femoral physeal fractures reported an incidence of 52% in growth disturbance, with 22% of the growth disturbance greater than 1.5cm. Arkader et al [22], reported a complication rate of 40% following distal femoral physeal fracture with growth arrest being the most common. The objective of this review was to determine whether surgery, in comparison to conservative treatment, is a safe and effective intervention for the management of distal femoral growth plate fractures
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